This excellent piece by Tina Rosenberg in The New York Times makes the case for advanced care planning as a standard, reimbursable practice in healthcare. Rosenberg cites not only personal experience with her mom but the example of La Crosse, Wisconsin, which Atul Gawande has profiled several times in his work on aging and end-of-life. In La Crosse, elderly residents spend far less time in the hospital in the last months of their life. The majority have written advanced directives and have had the discussion with their families. As Rosenberg highlights, it’s not the existence of these documents that matters most–it’s those conversations with family members and caretakers taking place as part of the process.
Rosenberg quotes Bernard Hammes, who led this work in La Crosse:
“It’s not: ‘How do you fill out this legal document,’ but ‘What does good care look like if you become ill and may not recover?’ At the most basic human level, what families face in those moments is, ‘What does it mean to love my mom or dad when they’re not going to recover, but we could still do some things to keep them alive? What does it mean to take good care of my mom at this point?’ “
But will our system support this? Starting January 1, Medicare may be able to pay for advanced care planning as a separate service with its own designated billing codes. There are also bills in both the Senate and the House to provide Medicare and/or Medicaid coverage for advanced care planning consultations. We hope these are part of a larger sea change in society come January!